Suggestion for Parents: Respect Children’s Medical Autonomy by Seeking Their Assent to Treatment

“Medical autonomy” refers to the right to decide what medical treatment a person is — or is not — willing to accept. In the United States, most minors (people younger than 18 years) don’t have medical autonomy because they can’t give legal consent to treatment. As a result, parents or guardians typically make medical decisions for them.  

However, the fact that minors can’t legally consent doesn’t mean that parents, guardians, and healthcare professionals shouldn’t seek their age-appropriate assent to treatment. Indeed, respecting children’s medical autonomy by seeking their assent to treatment is an excellent way for parents to start laying groundwork for a lifetime of positive healthcare interactions. Assent and consent are different. Consent is legal authorization to proceed. Assent is an active process that involves children, parents, and the healthcare professionals in a dialogue with multiple elements:

• Helping children achieve a developmentally appropriate awareness of the nature of their condition 
• Telling children what they can expect with tests and treatments 
• Making a clinical assessment of children’s understanding and the factors influencing how they are responding, including whether there is inappropriate pressure to accept testing or therapy
• Soliciting an expression of a child’s willingness to accept the proposed care(1)

Engaging children in age-appropriate conversations about their health care can start early. 

It has been suggested that assent from children as young as 7 years of age can help “foster moral growth and development of autonomy.”(2) Research shows that when children are involved in medical choices appropriate to their age and understanding, they experience less anxiety and a greater sense of control. Participating in the assent process can also cultivate and reinforce their ability to advocate for themselves as they grow.  

Seeking assent to treatment can be positive for parents and healthcare professionals as well as for children. Involving children in medical choices appropriate to their age and understanding reflects consideration for their feelings. It also shows that parents respect their ability to be active participants in a care plan, not simply passive recipients of ordered medical services. 

(1) Adapted from Policy Statement, American Academy of Pediatrics, Committee on Bioethics, “Informed Consent in Decision-Making in Pediatric Practice,”138 Pediatrics 2, August 1, 2016, reaffirmed January 2023) https://publications.aap.org/pediatrics/article/138/2/e20161484/52512/Informed-Consent-in-Decision-Making-in-Pediatric (accessed April 21, 2025)   

(2) Id.

Bioethicist in Residence, Lisa Goldman